Comparative Study of Functional Outcome of Minimally Displaced Scaphoid Fractures Treated by Conservative Method V/S Percutaneous Herbert Screw Fixation

Abstract

Background: Having an oblique orientation, scaphoid has a complex three dimensional structure. It acts as a tie-rod connecting the proximal and distal carpal rows. Scaphoid fractures account for 50 to 80% of carpal fractures. Due to the anatomy of its blood supply it is vulnerable to avascular necrosis. Non-operative treatment is acceptable for undisplaced fractures of scaphoid. However operative management is recommended for displaced scaphoid fractures. The aim of this study was to compare the functional outcome of minimally displaced scaphoid fractures treated by conservative method v/s percutaneous Herbert screw fixation. Methods: A randomized, prospective study of 20 patients was conducted at Krishna institute of medical sciences, Karad after obtaining approval from the ethical and research committee. 10 patients were operated with Herbert screw fixation and 10 patients were managed conservatively. All patients were followed up clinically and radiologically at 6 weeks, 3 months, 6 months and 12 months. Results: The male: female ratio in our study was 12:8.Most common mechanism of injury was due to fall on an outstretched hand. The time to return to work and sport was recorded in Weeks. Patients in the operative group consistently scored better on the modified Green/O’Brien score until 12 months. Patients in the operative group showed shorter time to union (Mean 6.6 weeks) and consequently quicker return to work (Mean time taken to return to work 6.6 weeks) compared to those treated non-operatively (Mean time to union 10.5 weeks and Mean time taken to return to work 9 weeks). Conclusion: Our study confirms earlier time to union and quicker return to work and sport with surgical screw fixation in case of minimally displaced fractures of the scaphoid. We recommend that all active patients with an minimally displaced fracture of the scaphoid should be offered surgical intervention with internal fixation.